Feature: MSU is Building a Foundation

MSU IS BUILDING A FOUNDATION FOR IMPROVING HEALTH CARE

By educating more primary care practicioners, MSU's medical colleges are building a solid foundation for health care reform. Health care reform, at least on the national level, has died a slow, painful death. But at Michigan State University, efforts to improve the way health care is taught and delivered are continuing.

When President Clinton's health care reform plan still had a pulse, two of the major components of the plan were access to quality health care by all people, and the education of more primary care providers. At MSU, these have long been the goals of the university's two medical colleges -- the College of Human Medicine (which trains M.D.s) and the College of Osteopathic Medicine (which trains D.O.s) -- and the College of Nursing. These colleges have long had a presence in communities throughout Michigan, taking the primary care message to the cities, towns and villages of the state. Human Medicine and Osteopathic Medicine have affiliations with hospitals in every corner of the state, including the Upper Peninsula. The College of Nursing has reached out, providing classes to nurses in many areas of Michigan, including the Muskegon, Grayling and Houghton Lake areas.

It was this community presence, coupled with MSU's strong commitment to primary care, that prompted the W.K. Kellogg Foundation in 1991 to award MSU a $6 million grant that would allow the university to expand its efforts at educating students in primary care. The project was titled 'Community Partnerships: A W.K. Kellogg Foundation Initiative in Health Professions Education.' MSU's project is titled 'Community/University Health Partnerships,' or C/UHP. MSU was one of seven sites nationwide that shared a $47.5 million grant from Kellogg, the Battle Creek- based foundation. The other sites were located in Massachusetts, Tennessee, Hawaii, Texas, West Virginia and Georgia.

The one thing all the locations had in common: A large segment of the population, both rural and urban, were in health care shortage areas -- not receiving the health care they needed. The goal of this undertaking is a sustained increase in the number of students who will choose careers of primary care in multidisciplinary community based health care rather than of urban hospitals. This is a clear way to help solve the current shortage of primary care providers.

'Typically, health professions education has been hospital based,' says Oliver Hayes, an associate professor of internal medicine and C\UHP project director. 'This project focuses on moving the education out of the hospital into ambulatory primary care. Additionally, the educational effort seeks to develop in students the skills, attitudes, and values that health care practitioners will need to function effectively in communities.'

This is being done by forming partnerships between the university and communities in three areas of the state -- one is in rural northern Michigan and two are in urban areas. In many ways, these are marriages made in heaven -- MSU supplies the students and the financial resources through the Kellogg grant, while the communities provide the sites of clinical education. 'People have this mistaken idea that you can't get good heath care in rural areas,' said Darrell Milner, who is the executive director of Northern Michigan Health Services, located in Houghton Lake. 'But that's just a myth and our project disproves that notion. Like most places, however, there aren't enough primary care nurses and doctors to provide needed care at an affordable cost.'

The university has forged linkages not only with Northern Michigan Health Services, which has clinics in Houghton Lake and Roscommon, but also with Thunder Bay Community Health Services (with sites in Hillman and Atlanta), and Saginaw Cooperative Hospitals, Inc. and Health Delivery, Inc. (at the James Street Academic Community Health Center in Lansing).

Saginaw Valley State University nursing students also participate in this program. The C/UHP project also has recently established a third site in Muskegon. Integral in the development of this site have been community hospitals, Muskegon Community College, and local practitioners.

Collaboration between the C/UHP project and another Kellogg Foundation project--the Comprehensive Community Health Models Project--is planned for this location in the near future. 'What we're finding helpful to us is the ability to develop a partnership with other health care professional colleagues and develop that partnership with the communities,' said Marilyn Rothert, dean of MSU's College of Nursing. 'We feel that both are essential for us to educate our students in ways in which they will be useful to the health care system in the future.'

Students to the Front Lines.

MSU profits from this venture by giving its medical and nursing students the opportunity to gain invaluable experience at the 'front lines' of health care. 'For the students, it's an incredible experience,' said Douglas Slater, a physician with Mercy Internal Medicine Associates of Grayling. 'We have a totally different patient population in many ways, and a completely different way of handling problems they only hear about.'

So far, 60 MSU students have taken advantage of the project, including 48 students, representing all three health professions colleges, who enrolled in the Fall 1994 Semester.

Karen Jorgensen, who, as a third-year College of Human Medicine student worked at the Saginaw sites, called the experience 'broadening.' 'There is a tremendous amount of exposure to different cultures, different views of what health care is from a patient's point of view, and varying degrees of problems that patients have when they come from a low-income situation,' Jorgensen said. 'I think the exposure is going to make me a better physician,' she continued. 'It's going to make me able to see more of what's going on for the patient and I think they'll benefit from that.'

Increasing the Number of Primary Care Providers.

Experts believe there is a serious shortage of primary care physicians in the United States. Today, it's estimated that only about 30 percent of the nation's doctors choose careers in primary care. 'One of the problems in the U.S. health system is an over-supply of specialists providing too many procedures and too little care, and that primary care practitioners are, in fact, vanishing,' said Andrew Hogan, an MSU health care economist who is a consultant to the project.

The ultimate goal of C/UHP is to increase the number of these 'primary care practitioners' who choose to practice in underserved areas. Community partners profit because their relationship with MSU can be used as a tool when recruiting heatlh care providers and retaining their services. 'We're going to be able to attract physicians and students to our area where they can see first hand what it's like to work in an underserved area,' said David Gamez, CEO of Saginaw's Health Delivery, Inc. 'And perhaps these students will choose a career in primary care as opposed to a specialty group.'

'This project clearly fits in well with MSU's land-grant philosophy,' Hayes says. 'Our educational niche is primary care education in communities, education in rural and underserved areas, and developing models of academic community health centers which demonstrate collaboration of various types of health care providers.'

Because MSU's health professions colleges had these community ties, some of the structure was already in place -- there was a foundation from which to work. The challenge, said Hayes, is to put this education model to work in a way that links the community and its needs to the academic institution.